State Replacement Forms
Please review our replacement policies to ensure when it is appropriate to replace another insurer's contract.
When replacing another insurer's contract, be certain you are obtaining all the appropriate forms. Please send the original copy of the state replacement form to Security Benefit, provide the applicant with a copy and retain a copy for the agent file.
Sales Literature Confirmation (PDF)
(Required on replacement cases for AK, AL, AR, AZ, CO, CT, FL, HI, IA, IN, KS, KY, LA, MD, ME, MN, MS, MT, NC, NE, NH, NJ, NM, NV, OH, OK, OR, RI, SC, SD, TX, UT, VA, VT, WI, WV)
Multi-State Replacement Form (PDF)
(AK, AL, AR, AZ, CO, CT, HI, IA, KY, LA, MD, ME, MS, MT, NC, NE, NH, NJ, NM, OH, OR, RI, SC, SD, TX, UT, VA, VT, WI, WV)